1
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Suresh H, Morgan BR, Mithani K, Warsi NM, Yan H, Germann J, Boutet A, Loh A, Gouveia FV, Young J, Quon J, Morgado F, Lerch J, Lozano AM, Al-Fatly B, Kühn AA, Laughlin S, Dewan MC, Mabbott D, Gorodetsky C, Bartels U, Huang A, Tabori U, Rutka JT, Drake JM, Kulkarni AV, Dirks P, Taylor MD, Ramaswamy V, Ibrahim GM. Postoperative cerebellar mutism syndrome is an acquired autism-like network disturbance. Neuro Oncol 2024; 26:950-964. [PMID: 38079480 PMCID: PMC11066932 DOI: 10.1093/neuonc/noad230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Cerebellar mutism syndrome (CMS) is a common and debilitating complication of posterior fossa tumor surgery in children. Affected children exhibit communication and social impairments that overlap phenomenologically with subsets of deficits exhibited by children with Autism spectrum disorder (ASD). Although both CMS and ASD are thought to involve disrupted cerebro-cerebellar circuitry, they are considered independent conditions due to an incomplete understanding of their shared neural substrates. METHODS In this study, we analyzed postoperative cerebellar lesions from 90 children undergoing posterior fossa resection of medulloblastoma, 30 of whom developed CMS. Lesion locations were mapped to a standard atlas, and the networks functionally connected to each lesion were computed in normative adult and pediatric datasets. Generalizability to ASD was assessed using an independent cohort of children with ASD and matched controls (n = 427). RESULTS Lesions in children who developed CMS involved the vermis and inferomedial cerebellar lobules. They engaged large-scale cerebellothalamocortical circuits with a preponderance for the prefrontal and parietal cortices in the pediatric and adult connectomes, respectively. Moreover, with increasing connectomic age, CMS-associated lesions demonstrated stronger connectivity to the midbrain/red nuclei, thalami and inferior parietal lobules and weaker connectivity to the prefrontal cortex. Importantly, the CMS-associated lesion network was independently reproduced in ASD and correlated with communication and social deficits, but not repetitive behaviors. CONCLUSIONS Our findings indicate that CMS-associated lesions may result in an ASD-like network disturbance that occurs during sensitive windows of brain development. A common network disturbance between CMS and ASD may inform improved treatment strategies for affected children.
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Affiliation(s)
- Hrishikesh Suresh
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin R Morgan
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Karim Mithani
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nebras M Warsi
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Han Yan
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Germann
- Division of Neurosurgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Flavia Venetucci Gouveia
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Julia Young
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Quon
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Felipe Morgado
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jason Lerch
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Andres M Lozano
- Division of Neurosurgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Bassam Al-Fatly
- Department of Neurology and Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité, Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology and Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité, Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Exzellenzcluster NeuroCure, Charité, Universitätsmedizin, Berlin, Germany
| | - Suzanne Laughlin
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Donald Mabbott
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Carolina Gorodetsky
- Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ute Bartels
- Division of Neuro-Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Annie Huang
- Division of Neuro-Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Uri Tabori
- Division of Neuro-Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - James T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James M Drake
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Abhaya V Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Peter Dirks
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Taylor
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Neuro-Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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2
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Malhotra AK, Nobre L, Ibrahim GM, Kulkarni AV, Drake JM, Rutka JT, Taylor MD, Ramaswamy V, Dirks PB, Dewan MC. Complications following resection of primary and recurrent pediatric posterior fossa ependymoma. J Neurosurg Pediatr 2024; 33:367-373. [PMID: 38241689 DOI: 10.3171/2023.11.peds23364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/28/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Extent of resection (EOR) is the most important modifiable prognostic variable for pediatric patients with posterior fossa ependymoma. An understanding of primary and recurrent ependymoma complications is essential to inform clinical decision-making for providers, patients, and families. In this study, the authors characterize postsurgical complications following resection of primary and recurrent pediatric posterior fossa ependymoma in a molecularly defined cohort. METHODS The authors conducted a 20-year retrospective single-center review of pediatric patients undergoing resection of posterior fossa ependymoma at the Hospital for Sick Children in Toronto, Canada. Complications were dichotomized into major and minor groups; EOR was compared across complication categories. The association between complication occurrence with length of stay (LOS) and mortality was also assessed using multivariable regressions. RESULTS There were 60 patients with primary resection included, 41 (68%) of whom were alive at the time of data collection. Gross-total resection was achieved in 33 (58%) of 57 patients at primary resection. There were no 30-day mortality events following primary and recurrent ependymoma resection. Following primary resection, 6 patients (10%) had posterior fossa syndrome (PFS) and 36 (60%) developed cranial neuropathies, 56% of which recovered within 1 year. One patient (1.7%) required a tracheostomy and 9 patients (15%) required gastrostomy tubes. There were 14 ventriculoperitoneal shunts (23%) inserted for postoperative hydrocephalus. Among recurrent cases, there were 48 recurrent resections performed in 24 patients. Complications included new cranial neuropathy in 10 patients (21%), of which 5 neuropathies resolved within 1 year. There were no cases of PFS following resection of recurrent ependymoma. Gastrostomy tube insertion was required in 3 patients (6.3%), and 1 patient (2.0%) required a tracheostomy. Given the differences in the location of tumor recurrence, a direct comparison between primary and recurrent resection complications was not feasible. Following multivariate analysis adjusting for sex, age, molecular status, and EOR, occurrence of major complications was found to be associated with prolonged LOS but not mortality. CONCLUSIONS These results detail the spectrum of postsurgical morbidity following primary and recurrent posterior fossa ependymoma resection. The crude complication rate following resection of infratentorial recurrent ependymoma was lower than that of primary ependymoma, although a statistical comparison revealed no significant differences between the groups. These results should serve to inform providers of the morbidity profile following surgical management of posterior fossa ependymoma and inform perioperative counseling of patients and their families.
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Affiliation(s)
| | - Liana Nobre
- 2Neuro-oncology Section, Division of Hematology/Oncology, Hospital for Sick Children, Toronto
| | - George M Ibrahim
- 3Division of Pediatric Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Abhaya V Kulkarni
- 3Division of Pediatric Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James M Drake
- 3Division of Pediatric Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James T Rutka
- 3Division of Pediatric Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael D Taylor
- 4Cancer and Hematology Center Brain Tumor Program, Texas Children's Hospital, Houston, Texas; and
| | - Vijay Ramaswamy
- 2Neuro-oncology Section, Division of Hematology/Oncology, Hospital for Sick Children, Toronto
| | - Peter B Dirks
- 3Division of Pediatric Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael C Dewan
- 5Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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3
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Hopkins BS, Carter B, Lord J, Rutka JT, Cohen-Gadol AA. Editorial. AtlasGPT: dawn of a new era in neurosurgery for intelligent care augmentation, operative planning, and performance. J Neurosurg 2024; 140:1211-1214. [PMID: 38412477 DOI: 10.3171/2024.2.jns232997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Benjamin S Hopkins
- 1Department of Neurological Surgery, Keck Medicine of University of Southern California, Los Angeles, California
| | - Bob Carter
- 2Harvard University and Massachusetts General Hospital, Boston, Massachusetts
| | - Jesse Lord
- 3The Neurosurgical Atlasand Atlas Meditech, Carmel, Indiana
| | - James T Rutka
- 4Editor-in-Chief, Journal of Neurosurgery Publishing Group; and
| | - Aaron A Cohen-Gadol
- 3The Neurosurgical Atlasand Atlas Meditech, Carmel, Indiana
- 5Department of Neurological Surgery, Indiana University, Indianapolis, Indiana
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4
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Parney IF, Warnick RE, Lang FF, Rutka JT, Kalkanis S, Glick R, Rosenblum ML, Germano IM. The AANS/CNS Section on Tumors: a summary of 40 years of advocacy to advance the care of patients with brain and spine tumors. J Neurosurg 2024:1-7. [PMID: 38277647 DOI: 10.3171/2023.12.jns232781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/26/2023] [Indexed: 01/28/2024]
Abstract
The AANS/CNS Section on Tumors was founded 40 years ago in 1984 to assist in the education of neurosurgeons interested in neuro-oncology, and serves as a resource for other national organizations regarding the clinical treatment of nervous system tumors. The Section on Tumors was the first national physicians' professional organization dedicated to the study and treatment of patients with brain and spine tumors. Over the past 40 years, the Section on Tumors has built solid foundations, including establishing the tumor section satellite meetings, founding the Journal of Neuro-Oncology (the first medical journal dedicated to brain and spine surgical oncology), advancing surgical neuro-oncology education and research, promoting neurosurgical involvement in neuro-oncology clinical trials, and advocating for patients with brain and spine tumors. This review provides a synopsis of the Section on Tumors' history, its challenges, and its opportunities, drawing on the section's archives and input from the 17 section chairs who led it during its first 40 years.
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Affiliation(s)
- Ian F Parney
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Frederick F Lang
- 3Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas
| | - James T Rutka
- 4Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Steven Kalkanis
- 5Department of Neurosurgery, Henry Ford Health, Detroit, Michigan
| | - Roberta Glick
- 6Department of Neurosurgery, Rush University, Chicago, Illinois; and
| | - Mark L Rosenblum
- 5Department of Neurosurgery, Henry Ford Health, Detroit, Michigan
| | - Isabelle M Germano
- 7Department of Neurosurgery, Icahn School of Medicine, Mount Sinai, New York, New York
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5
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Woolman M, Kiyota T, Belgadi SA, Fujita N, Fiorante A, Ramaswamy V, Daniels C, Rutka JT, McIntosh C, Munoz DG, Ginsberg HJ, Aman A, Zarrine-Afsar A. Lipidomic-Based Approach to 10 s Classification of Major Pediatric Brain Cancer Types with Picosecond Infrared Laser Mass Spectrometry. Anal Chem 2024; 96:1019-1028. [PMID: 38190738 PMCID: PMC10809247 DOI: 10.1021/acs.analchem.3c03156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024]
Abstract
Picosecond infrared laser mass spectrometry (PIRL-MS) is shown, through a retrospective patient tissue study, to differentiate medulloblastoma cancers from pilocytic astrocytoma and two molecular subtypes of ependymoma (PF-EPN-A, ST-EPN-RELA) using laser-extracted lipids profiled with PIRL-MS in 10 s of sampling and analysis time. The average sensitivity and specificity values for this classification, taking genomic profiling data as standard, were 96.41 and 99.54%, and this classification used many molecular features resolvable in 10 s PIRL-MS spectra. Data analysis and liquid chromatography coupled with tandem high-resolution mass spectrometry (LC-MS/MS) further allowed us to reduce the molecular feature list to only 18 metabolic lipid markers most strongly involved in this classification. The identified 'metabolite array' was comprised of a variety of phosphatidic and fatty acids, ceramides, and phosphatidylcholine/ethanolamine and could mediate the above-mentioned classification with average sensitivity and specificity values of 94.39 and 98.78%, respectively, at a 95% confidence in prediction probability threshold. Therefore, a rapid and accurate pathology classification of select pediatric brain cancer types from 10 s PIRL-MS analysis using known metabolic biomarkers can now be available to the neurosurgeon. Based on retrospective mining of 'survival' versus 'extent-of-resection' data, we further identified pediatric cancer types that may benefit from actionable 10 s PIRL-MS pathology feedback. In such cases, aggressiveness of the surgical resection can be optimized in a manner that is expected to benefit the patient's overall or progression-free survival. PIRL-MS is a promising tool to drive such personalized decision-making in the operating theater.
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Affiliation(s)
- Michael Woolman
- Princess
Margaret Cancer Centre, University Health
Network, 101 College
Street, Toronto, Ontario M5G 1L7, Canada
- Department
of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Taira Kiyota
- Ontario
Institute for Cancer Research (OICR), 661 University Ave Suite 510, Toronto, Ontario M5G 0A3, Canada
| | - Siham A. Belgadi
- Department
of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Naohide Fujita
- Arthur
and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada
| | - Alexa Fiorante
- Princess
Margaret Cancer Centre, University Health
Network, 101 College
Street, Toronto, Ontario M5G 1L7, Canada
- Department
of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Vijay Ramaswamy
- Department
of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
- Arthur
and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada
| | - Craig Daniels
- Arthur
and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada
| | - James T. Rutka
- Arthur
and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada
- Department
of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada
| | - Chris McIntosh
- Toronto
General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G-2C4, Canada
| | - David G. Munoz
- Keenan
Research Center for Biomedical Science & the Li Ka Shing Knowledge
Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
- Department
of Laboratory Medicine and Pathobiology, University of Toronto, 1 King’s College Circle, Sixth Floor, Toronto,Ontario M5S 1A8, Canada
| | - Howard J. Ginsberg
- Department
of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada
- Keenan
Research Center for Biomedical Science & the Li Ka Shing Knowledge
Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
- Department
of Laboratory Medicine and Pathobiology, University of Toronto, 1 King’s College Circle, Sixth Floor, Toronto,Ontario M5S 1A8, Canada
| | - Ahmed Aman
- Ontario
Institute for Cancer Research (OICR), 661 University Ave Suite 510, Toronto, Ontario M5G 0A3, Canada
- Leslie
Dan, Faculty of Pharmacy, University of
Toronto, 144 College
Street, Toronto, Ontario M5S 3M2, Canada
| | - Arash Zarrine-Afsar
- Princess
Margaret Cancer Centre, University Health
Network, 101 College
Street, Toronto, Ontario M5G 1L7, Canada
- Department
of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
- Department
of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada
- Keenan
Research Center for Biomedical Science & the Li Ka Shing Knowledge
Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
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6
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Sakhrekar R, McVey MJ, Rutka JT, Camp M. Correction: Use of monopolar cautery in patient with a vagal nerve stimulator during neuromuscular scoliosis surgery. Spine Deform 2023; 11:1551. [PMID: 37535307 DOI: 10.1007/s43390-023-00729-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Affiliation(s)
- Rajendra Sakhrekar
- Division of Orthopaedic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Division of Orthopaedic Surgery, University of Toronto, Toronto, 149 College Street, Room 508-A , ON, M5T 1P5, Canada.
| | - M J McVey
- Department of Translational Medicine, The Hospital for Sick Children Research Institute, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Departments of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Physics, Toronto Metropolitan University The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - J T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, M5G 1X8, Toronto, ON, Canada
| | - Mark Camp
- Division of Orthopaedic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Division of Orthopaedic Surgery, University of Toronto, Toronto, 149 College Street, Room 508-A , ON, M5T 1P5, Canada
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7
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Sakhrekar R, McVey MJ, Rutka JT, Camp M. Use of monopolar cautery in patient with a vagal nerve stimulator during neuromuscular scoliosis surgery. Spine Deform 2023; 11:1539-1542. [PMID: 37306937 DOI: 10.1007/s43390-023-00705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/13/2023] [Indexed: 06/13/2023]
Abstract
It is a historic and common practice while performing spine surgery on patients with a VNS has been to have the patient's neurologist turn off the VNS generator in the pre-operative anesthetic care unit and to use bipolar rather than monopolar electrocautery. Here we report a case of a 16-year-old male patient with cerebral palsy and refractory epilepsy managed with an implanted VNS who had scoliosis surgery (and subsequent hip surgery) conducted with the use of monopolar cautery. Although VNS manufacturer guidelines suggest that monopolar cautery should be avoided, perioperative care providers should consider its selective use in high-risk instances (with greater risks of morbidity and mortality due to blood loss which outweigh the risk of surgical re-insertion of a VNS) such as cardiac or major orthopedic surgery. Considering the number of patients with VNS devices presenting for major orthopedic surgery is increasing, it is important to have an approach and strategy for perioperative management of VNS devices.
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Affiliation(s)
- Rajendra Sakhrekar
- Division of Orthopaedic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Division of Orthopaedics, Department of Surgery, University of Toronto, Room 508-A, 149 College Street, Toronto, ON, M5T 1P5, Canada.
| | - M J McVey
- Department of Translational Medicine, The Hospital for Sick Children Research Institute, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Departments of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Physics, Toronto Metropolitan University The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - J T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Mark Camp
- Division of Orthopaedic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Division of Orthopaedics, Department of Surgery, University of Toronto, Room 508-A, 149 College Street, Toronto, ON, M5T 1P5, Canada
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8
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Yossofzai O, Stone SSD, Madsen JR, Wang S, Ragheb J, Mohamed I, Bollo RJ, Clarke D, Perry MS, Weil AG, Raskin JS, Pindrik J, Ahmed R, Lam SK, Fallah A, Maniquis C, Andrade A, Ibrahim GM, Drake J, Rutka JT, Tailor J, Mitsakakis N, Widjaja E. Machine learning models for predicting seizure outcome after MR-guided laser interstitial thermal therapy in children. J Neurosurg Pediatr 2023; 32:739-749. [PMID: 37856414 DOI: 10.3171/2023.8.peds23240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/15/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE MR-guided laser interstitial thermal therapy (MRgLITT) is associated with lower seizure-free outcome but better safety profile compared to open surgery. However, the predictors of seizure freedom following MRgLITT remain uncertain. This study aimed to use machine learning to predict seizure-free outcome following MRgLITT and to identify important predictors of seizure freedom in children with drug-resistant epilepsy. METHODS This multicenter study included children treated with MRgLITT for drug-resistant epilepsy at 13 epilepsy centers. The authors used clinical data, diagnostic investigations, and ablation features to predict seizure-free outcome at 1 year post-MRgLITT. Patients from 12 centers formed the training cohort, and patients in the remaining center formed the testing cohort. Five machine learning algorithms were developed on the training data by using 10-fold cross-validation, and model performance was measured on the testing cohort. The models were developed and tested on the complete feature set. Subsequently, 3 feature selection methods were used to identify important predictors. The authors then assessed performance of the parsimonious models based on these important variables. RESULTS This study included 268 patients who underwent MRgLITT, of whom 44.4% had achieved seizure freedom at 1 year post-MRgLITT. A gradient-boosting machine algorithm using the complete feature set yielded the highest area under the curve (AUC) on the testing set (AUC 0.67 [95% CI 0.50-0.82], sensitivity 0.71 [95% CI 0.47-0.88], and specificity 0.66 [95% CI 0.50-0.81]). Logistic regression, random forest, support vector machine, and neural network yielded lower AUCs (0.58-0.63) compared to the gradient-boosting machine but the findings were not statistically significant (all p > 0.05). The 3 feature selection methods identified video-EEG concordance, lesion size, preoperative seizure frequency, and number of antiseizure medications as good prognostic features for predicting seizure freedom. The parsimonious models based on important features identified by univariate feature selection slightly improved model performance compared to the complete feature set. CONCLUSIONS Understanding the predictors of seizure freedom after MRgLITT will assist with prognostication.
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Affiliation(s)
- Omar Yossofzai
- Departments of1Diagnostic Imaging and
- 2Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Scellig S D Stone
- 3Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
| | - Joseph R Madsen
- 3Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
| | - Shelly Wang
- 4Department of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida
| | - John Ragheb
- 4Department of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida
| | - Ismail Mohamed
- 5Division of Pediatric Neurology, University of Alabama, Birmingham, Alabama
| | - Robert J Bollo
- 6Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Dave Clarke
- 7Department of Neurology, Dell Medical School, Austin, Texas
| | - M Scott Perry
- 8Justin Neurosciences Center, Cook Children's Medical Center, Fort Worth, Texas
| | - Alexander G Weil
- 9Department of Neurosurgery, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Jeffrey S Raskin
- 10Department of Neurological Surgery, Riley Hospital for Children, Indianapolis, Indiana
- 11Division of Neurosurgery, Lurie Children's Hospital, Chicago, Illinois
| | - Jonathan Pindrik
- 12Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Raheel Ahmed
- 13Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin
| | - Sandi K Lam
- 11Division of Neurosurgery, Lurie Children's Hospital, Chicago, Illinois
| | - Aria Fallah
- 14Department of Neurosurgery, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Cassia Maniquis
- 14Department of Neurosurgery, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Andrea Andrade
- 15Department of Paediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - George M Ibrahim
- 16Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Drake
- 16Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James T Rutka
- 16Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jignesh Tailor
- 10Department of Neurological Surgery, Riley Hospital for Children, Indianapolis, Indiana
| | - Nicholas Mitsakakis
- 17Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Elysa Widjaja
- Departments of1Diagnostic Imaging and
- 18Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada; and
- 19Medical Imaging, Lurie Children's Hospital, Chicago, Illinois
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9
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Christian E, Romach M, Rutka JT. Assistance amidst air alerts and angst: Ukraine unbroken. J Neurosurg 2023; 140:600-603. [PMID: 37878008 DOI: 10.3171/2023.8.jns231781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- Eisha Christian
- 1Division of Neurological Surgery, Southern California Permanente Medical Group, Los Angeles Medical Center, Los Angeles, California; Departments of
| | - Myroslava Romach
- 2Psychiatry and
- 3Surgery, University of Toronto, Ontario, Canada; and
| | - James T Rutka
- 4Department of Surgery, Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
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10
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11
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Malvea A, Malhotra AK, Schmitz A, Parker W, Yefet L, Muthusami P, Rutka JT, Dirks P. Ocular needlefish injury with cavernous sinus thrombosis and carotid-cavernous fistula: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22477. [PMID: 37127033 PMCID: PMC10555567 DOI: 10.3171/case22477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND The Belonidae family of fish has been implicated in various penetrating injuries; to date, however, there have been limited reports of brain injury due to this species. OBSERVATIONS The authors present the case of a young patient who suffered an ocular penetrating injury from a needlefish with a resultant cavernous sinus thrombosis and concomitant carotid-cavernous fistula. This case highlights the interdisciplinary management of this rare condition through a strategy of anticoagulation titration to the endpoint of fistula closure. LESSONS Through this report the importance of a high index of suspicion for neurovascular injury and fistula formation in penetrating ocular injuries is highlighted as well as the importance of interdisciplinary management of patients with such injuries and their sequelae.
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Affiliation(s)
- Anahita Malvea
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; and
| | - Armaan K. Malhotra
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; and
| | - Ann Schmitz
- Department of Surgery, Division of Neurosurgery, and
| | | | - Leeor Yefet
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; and
| | - Prakash Muthusami
- Department of Medical Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Peter Dirks
- Department of Surgery, Division of Neurosurgery, and
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12
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Malhotra AK, Nobre LF, Ibrahim GM, Kulkarni AV, Drake JM, Rutka JT, Bouffet E, Taylor MD, Tsang D, Ramaswamy V, Dirks PB, Dewan MC. Correction to: Outcomes following management of relapsed pediatric posterior fossa ependymoma in the molecular era. J Neurooncol 2023; 163:291. [PMID: 37115469 DOI: 10.1007/s11060-023-04321-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Armaan K Malhotra
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Liana F Nobre
- Neuro-oncology Section, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - George M Ibrahim
- Division of Pediatric Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Abhaya V Kulkarni
- Division of Pediatric Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - James M Drake
- Division of Pediatric Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - James T Rutka
- Division of Pediatric Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Eric Bouffet
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Michael D Taylor
- Division of Pediatric Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Derek Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Vijay Ramaswamy
- Neuro-oncology Section, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Peter B Dirks
- Division of Pediatric Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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13
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Barker FG, Rutka JT. Editorial. Generative artificial intelligence, chatbots, and the Journal of Neurosurgery Publishing Group. J Neurosurg 2023; 139:901-903. [PMID: 37119115 DOI: 10.3171/2023.4.jns23482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Fred G Barker
- 1Associate Editor,Journal of Neurosurgery, Journal of Neurosurgery: Spine, andJournal of Neurosurgery: Pediatrics; and
| | - James T Rutka
- 2Editor-in-Chief, Journal of Neurosurgery Publishing Group
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14
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Couldwell WT, Rutka JT. Editorial. Margie Shreve and the Journal of Neurosurgery: "May it be said, 'Well done.'". J Neurosurg 2023:1-3. [PMID: 37060311 DOI: 10.3171/2023.3.jns23172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- William T Couldwell
- 1Editor-in-Chief,Neurosurgical FocusandNeurosurgical Focus: Video, Journal of Neurosurgery Publishing Group; and
| | - James T Rutka
- 2Editor-in-Chief, Journal of Neurosurgery Publishing Group
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15
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Couldwell WT, Harbaugh RE, Rutka JT. Editorial. Pitfalls in the practice of neurosurgery: identifying those at greatest risk. J Neurosurg 2023; 138:1175-1177. [PMID: 36708531 DOI: 10.3171/2022.12.jns222826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- William T Couldwell
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Robert E Harbaugh
- 2Penn State Health Faculty Medical Group, Hershey, Pennsylvania; and
| | - James T Rutka
- 3Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
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16
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Lohkamp LN, Holowka S, Widjaja E, Manicat-Emo A, Rutka JT. Transorbital penetrating head injury with a favorable outcome: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22440. [PMID: 36647248 PMCID: PMC9844526 DOI: 10.3171/case22440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/15/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transorbital penetrating head injuries (PHIs) are uncommon but can lead to substantial deficits, depending on intracranial involvement and the neuroanatomical structures affected. Complete recovery after such injuries is rare. OBSERVATIONS A 7-year-old boy sustained a PHI when he fell onto a garden spike while climbing a fence. Initial imaging showed an orbital roof fracture, focal subarachnoid hemorrhage, and an intraparenchymal hemorrhage in the right frontal lobe with associated linear tract extending to the contralateral superior temporal gyrus. Relevant neuroanatomical structures, including the anterior cerebral arteries (ACAs) and the basal ganglia, were spared. This is in keeping with superior transorbital PHI caused by a garden spike, which had transgressed the skull entering from the right superior orbit. Clinically, he experienced some transient right-sided weakness and mild speech disturbance. Some questionable vasospasm of the ACAs observed on interim magnetic resonance imaging was absent in a repeat imaging study, followed by an unremarkable radiographic follow-up at 6 months after injury. At 18 months after injury, he is neurologically intact without deficit. LESSONS Most PHIs bear serious lifelong consequences, but here was a case of a deep, penetrating object that managed to avoid all significant neuroanatomical pathways, leading to complete recovery in follow-up.
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Affiliation(s)
| | - Stephanie Holowka
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
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17
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Georgiou C, Cai Z, Alsaden N, Cho H, Behboudi M, Winnik MA, Rutka JT, Reilly RM. Treatment of Orthotopic U251 Human Glioblastoma Multiforme Tumors in NRG Mice by Convection-Enhanced Delivery of Gold Nanoparticles Labeled with the β-Particle-Emitting Radionuclide, 177Lu. Mol Pharm 2023; 20:582-592. [PMID: 36516432 PMCID: PMC9812026 DOI: 10.1021/acs.molpharmaceut.2c00815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In this study, we investigated convection-enhanced delivery (CED) of 23 ± 3 nm gold nanoparticles (AuNPs) labeled with the β-particle-emitting radionuclide 177Lu (177Lu-AuNPs) for treatment of orthotopic U251-Luc human glioblastoma multiforme (GBM) tumors in NRG mice. The cytotoxicity in vitro of 177Lu-AuNPs (0.0-2.0 MBq, 4 × 1011 AuNPs) on U251-Luc cells was also studied by a clonogenic survival assay, and DNA double-strand breaks (DSBs) caused by β-particle emissions of 177Lu were measured by confocal immunofluorescence microscopy for γH2AX. NRG mice with U251-Luc tumors in the right cerebral hemisphere of the brain were treated by CED of 1.1 ± 0.2 MBq of 177Lu-AuNPs (4 × 1011 AuNPs). Control mice received unlabeled AuNPs or normal saline. Tumor retention of 177Lu-AuNPs was assessed by single-photon emission computed tomography/computed tomography (SPECT/CT) imaging and biodistribution studies. Radiation doses were estimated for the tumor, brain, and other organs. The effectiveness for treating GBM tumors was determined by bioluminescence imaging (BLI) and T2-weighted magnetic resonance imaging (MRI) and by Kaplan-Meier median survival. Normal tissue toxicity was assessed by monitoring body weight and hematology and blood biochemistry analyses at 14 d post-treatment. 177Lu-AuNPs (2.0 MBq, 4 × 1011 AuNPs) decreased the clonogenic survival of U251-Luc cells to 0.005 ± 0.002 and increased DNA DSBs by 14.3-fold compared to cells treated with unlabeled AuNPs or normal saline. A high proportion of 177Lu-AuNPs was retained in the U251-Luc tumor in NRG mice up to 21 d with minimal re-distribution to the brain or other organs. The radiation dose in the tumor was high (599 Gy). The dose in the normal right cerebral hemisphere of the brain excluding the tumor was 93-fold lower (6.4 Gy), and 2000-3000-fold lower doses were calculated for the contralateral left cerebral hemisphere (0.3 Gy) or cerebellum (0.2 Gy). The doses in peripheral organs were <0.1 Gy. BLI revealed almost complete tumor growth arrest in mice treated with 177Lu-AuNPs, while tumors grew rapidly in control mice. MRI at 28 d post-treatment and histological staining showed no visible tumor in mice treated with 177Lu-AuNPs but large GBM tumors in control mice. All control mice reached a humane endpoint requiring sacrifice within 39 d (normal saline) or 45 d post-treatment (unlabeled AuNPs), while 5/8 mice treated with 177Lu-AuNPs survived up to 150 d. No normal tissue toxicity was observed in mice treated with 177Lu-AuNPs. We conclude that CED of 177Lu-AuNPs was highly effective for treating U251-Luc human GBM tumors in the brain in NRG mice at amounts that were non-toxic to normal tissues. These 177Lu-AuNPs administered by CED hold promise for treating patients with GBM to prevent recurrence and improve long-term outcome.
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Affiliation(s)
- Constantine
J. Georgiou
- Department
of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, OntarioM5S 3M2, Canada
| | - Zhongli Cai
- Department
of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, OntarioM5S 3M2, Canada
| | - Noor Alsaden
- Department
of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, OntarioM5S 3M2, Canada
| | - Hyungjun Cho
- Department
of Chemistry, University of Toronto, 80 St. George Street, Toronto, OntarioM5S 3H6, Canada
| | - Minou Behboudi
- Department
of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, OntarioM5S 3M2, Canada
| | - Mitchell A. Winnik
- Department
of Chemistry, University of Toronto, 80 St. George Street, Toronto, OntarioM5S 3H6, Canada
| | - James T. Rutka
- Division
of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Toronto, OntarioM5G 1X8, Canada,Division
of Neurosurgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 149 College Street, Toronto, OntarioM5T 1P5, Canada
| | - Raymond M. Reilly
- Department
of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, OntarioM5S 3M2, Canada,Department
of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, OntarioM5S 1A8, Canada,Joint Department
of Medical Imaging and Princess Margaret Cancer Centre, University Health Network, Toronto, OntarioM5G 2C1, Canada,
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18
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Thiong'o GM, Looi T, Rutka JT, Kulkarni AV, Drake JM. Design and validation of a hemispherectomy simulator for neurosurgical education. J Neurosurg 2023; 138:1-8. [PMID: 35901759 DOI: 10.3171/2022.5.jns22545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/04/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Early adaptors of surgical simulation have documented a translation to improved intraoperative surgical performance. Similar progress would boost neurosurgical education, especially in highly nuanced epilepsy surgeries. This study introduces a hands-on cerebral hemispheric surgery simulator and evaluates its usefulness in teaching epilepsy surgeries. METHODS Initially, the anatomical realism of the simulator and its perceived effectiveness as a training tool were evaluated by two epilepsy neurosurgeons. The surgeons independently simulated hemispherotomy procedures and provided questionnaire feedback. Both surgeons agreed on the anatomical realism and effectiveness of this training tool. Next, construct validity was evaluated by modeling the proficiency (task-completion time) of 13 participants, who spanned the experience range from novice to expert. RESULTS Poisson regression yielded a significant whole-model fit (χ2 = 30.11, p < 0.0001). The association between proficiency when using the training tool and the combined effect of prior exposure to hemispherotomy surgery and career span was statistically significant (χ2 = 7.30, p = 0.007); in isolation, pre-simulation exposure to hemispherotomy surgery (χ2 = 6.71, p = 0.009) and career length (χ2 = 14.21, p < 0.001) were also significant. The mean (± SD) task-completion time was 25.59 ± 9.75 minutes. Plotting career length against task-completion time provided insights on learning curves of epilepsy surgery. Prediction formulae estimated that 10 real-life hemispherotomy cases would be needed to approach the proficiency seen in experts. CONCLUSIONS The cerebral hemispheric surgery simulator is a reasonable epilepsy surgery training tool in the quest to increase preoperative practice opportunities for neurosurgical education.
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Affiliation(s)
- Grace M Thiong'o
- 1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and.,2Department of Surgery, University of Toronto, Ontario, Canada
| | - Thomas Looi
- 1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and
| | - James T Rutka
- 2Department of Surgery, University of Toronto, Ontario, Canada
| | | | - James M Drake
- 1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and.,2Department of Surgery, University of Toronto, Ontario, Canada
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19
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Agnihotri S, Golbourn B, Huang X, Remke M, Younger S, Cairns RA, Chalil A, Smith CA, Krumholtz SL, Mackenzie D, Rakopoulos P, Ramaswamy V, Taccone MS, Mischel PS, Fuller GN, Hawkins C, Stanford W, Taylor MD, Zadeh G, Rutka JT. Correction: PINK1 Is a Negative Regulator of Growth and the Warburg Effect in Glioblastoma. Cancer Res 2022; 82:4695. [DOI: 10.1158/0008-5472.can-22-3445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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20
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Ashley WW, Eden SV, Rutka JT. Equity in neurosurgical scientific publication. J Neurosurg 2022; 138:575-576. [PMID: 35962967 DOI: 10.3171/2022.7.jns221407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- William W Ashley
- 1Department of Neurosurgery, Sandra and Malcolm Berman Brain and Spine Institute, Towson, Maryland.,2Department of Neurosurgery, Sinai Hospital of Baltimore and LifeBridge Health System, Baltimore, Maryland
| | - Sonia V Eden
- 3Department of Neurosurgery, Semmes Murphey Clinic and University of Tennessee Health Sciences Center, Memphis, Tennessee; and
| | - James T Rutka
- 4Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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21
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Lohkamp LN, Kulkarni AV, Drake JM, Rutka JT, Dirks PB, Taylor M, Ibrahim GM, Hamilton J, Bartels UK. Preservation of endocrine function after Ommaya reservoir insertion in children with cystic craniopharyngioma. J Neurooncol 2022; 159:597-607. [PMID: 35925530 DOI: 10.1007/s11060-022-04099-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/16/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Children with craniopharyngiomas (CP) can experience significant morbidities caused by extensive surgery and/or radiation. Ommaya reservoir insertion (ORI) into cystic CP represents a minimally invasive approach allowing immediate decompression and aims to avoid additional injuries. The purpose of this study was to determine the surgical outcome and relevance of upfront ORI (± intracystic treatment) for preservation of endocrine function. METHODS We performed a retrospective chart review of children with CP treated at the Hospital for Sick Children between 01/01/2000 and 15/01/2020. Endocrine function was reviewed at the time of initial surgery and throughout follow-up. New endocrinological deficits related to the index procedure were defined as immediate failure (IF), whereas postoperative duration of endocrinological stability (ES) was analyzed using the Kaplan-Meier method. The rate of IF and ES was compared between the treatment groups. RESULTS Seventy-nine patients were included and had a median age of 8.3 years (range 2.1-18.0 years); 31 were males. Fifty-three patients with upfront surgical treatment, including 29 ORI and 24 gross total or partial resections had sufficient endocrinological follow-up data. Endocrine dysfunction occurring immediately after the index procedure (IF) was observed in 15 patients (62.5%) in the resection group compared to two patients (6.8%) in the ORI group, odds ratio: 0.05 (CI: 0.01-0.26, p < 0.0001). Excluding those with immediate endocrinological deficits, mean ES after ORI was 19.4 months (CI: 11.6-34.2), compared to 13.4 months (CI:10.6-NA) after surgical resection. CONCLUSIONS Endocrine function was preserved in patients with upfront ORI (± intracystic treatment), which was confirmed as a minimally invasive procedure with an overall low morbidity profile.
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Affiliation(s)
- Laura-Nanna Lohkamp
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Abhaya V Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - James M Drake
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - James T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Peter B Dirks
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Michael Taylor
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - George M Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jill Hamilton
- Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ute K Bartels
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G2J9, Canada.
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22
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Warsi NM, Yan H, Wong SM, Yau I, Breitbart S, Go C, Gorodetsky C, Fasano A, Kalia SK, Rutka JT, Vaughan K, Ibrahim GM. Vagus Nerve Stimulation Modulates Phase-Amplitude Coupling in Thalamic Local Field Potentials. Neuromodulation 2022; 26:601-606. [PMID: 35840521 DOI: 10.1016/j.neurom.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/26/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The antiseizure effects of vagus nerve stimulation (VNS) are thought to be mediated by the modulation of afferent thalamocortical circuitry. Cross-frequency phase-amplitude coupling (PAC) is a mechanism of hierarchical network coordination across multiple spatiotemporal scales. In this study, we leverage local field potential (LFP) recordings from the centromedian (CM) (n = 3) and anterior (ATN) (n = 2) nuclei in five patients with tandem thalamic deep brain stimulation and VNS to study neurophysiological changes in the thalamus in response to VNS. MATERIALS AND METHODS Bipolar LFP data were recorded from contact pairs spanning target nuclei in VNS "on" and "off" states. RESULTS Active VNS was associated with increased PAC between theta, alpha, and beta phase and gamma amplitude in CM (q < 0.05). Within the ATN, PAC changes also were observed, although these were less robust. In both nuclei, active VNS also modulated interhemispheric bithalamic functional connectivity. CONCLUSIONS We report that VNS is associated with enhanced PAC and coordinated interhemispheric interactions within and between thalamic nuclei, respectively. These findings advance understanding of putative neurophysiological effects of acute VNS and contextualize previous animal and human studies showing distributed cortical synchronization after VNS.
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Affiliation(s)
- Nebras M Warsi
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Han Yan
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Simeon M Wong
- Department of Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ivanna Yau
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sara Breitbart
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cristina Go
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - James T Rutka
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kerry Vaughan
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Department of Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.
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23
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Lohkamp LN, Kulkarni AV, Drake J, Rutka JT, Hamilton J, Bartels UK. RARE-23. Preservation of endocrine function after Ommaya reservoir insertion in children with cystic craniopharyngioma. Neuro Oncol 2022. [PMCID: PMC9165069 DOI: 10.1093/neuonc/noac079.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION: Children with craniopharyngiomas (CP) can be subjected to significant morbidities caused by radical surgery and/or radiation with deleterious long-term consequences. Ommaya reservoir insertion (ORI) into cystic CP represents a minimally invasive procedure allowing immediate decompression and aims to avoid additional injuries. The purpose of this study was to determine the relevance of upfront ORI (+/- intracystic treatment) for preservation of endocrine function. METHODS: We performed a retrospective chart review of children with CP treated at the Hospital for Sick Children between 01/01/2000 and 15/01/2020 for review of endocrinological outcome after ORI. Endocrine function was reviewed at the time of initial surgery and throughout the course of follow-up. Event-free survival (EFS) was defined as the time to further surgical resection or irradiation. RESULTS: Seventy-nine patients were identified with a median age of 8.3 (range 2.1-18.0) years, 31 were males. Sixty-six patients underwent surgical treatment, including 41 ORI. ORI was performed as upfront treatment in 32 patients; 33 patients underwent gross total or partial resection and 1 patient radiotherapy as first treatment. Fifty-five of 79 patients had sufficient endocrine follow-up data. Endocrine function remained stable after ORI with a mean EFS of 27.64 (± 5.22) months. Surgical resection was associated with worsened endocrine function postoperatively with an EFS of 5.48 (± 1.74) months (p< 0.001). CONCLUSIONS: Upfront ORI (+/- intracystic treatment) resulted in endocrine preservation of all patients and a significantly longer EFS when compared to upfront surgical resection in this single institutional retrospective review. Further analyses will elucidate the implications of ORI with respect to ophthalmological, vascular and neurocognitive outcome.
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Affiliation(s)
| | | | - James Drake
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | - James T Rutka
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Jill Hamilton
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Ute K Bartels
- The Hospital for Sick Children , Toronto, Ontario , Canada
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Alanazi R, Nakatogawa H, Wang H, Ji D, Luo Z, Golbourn B, Feng Z, Rutka JT, Sun H. Inhibition of TRPM7 with carvacrol suppresses glioblastoma functions
in vivo. Eur J Neurosci 2022; 55:1483-1491. [DOI: 10.1111/ejn.15647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Haitao Wang
- Departments of Surgery
- Departments of Surgery Physiology
| | | | - Zhengwei Luo
- Departments of Surgery
- Departments of Surgery Physiology
| | - Brian Golbourn
- Departments of Cell Biology SickKids Research Institute, The Hospital for Sick Children Toronto Canada
| | | | | | - Hong‐Shuo Sun
- Departments of Surgery
- Departments of Surgery Physiology
- Pharmacology, Temerty Faculty of Medicine
- Leslie Dan Faculty of Pharmacy University of Toronto Toronto Canada
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25
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McLeod R, Keshavjee S, Ahmed N, Richards R, Fehlings MG, Nathens A, Rotstein OD, Rutka JT. History of the Department of Surgery at the University of Toronto: celebrating a centennial of progress and innovation. Can J Surg 2022; 65:E56-E65. [PMID: 35115318 PMCID: PMC8820838 DOI: 10.1503/cjs.013621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/09/2022] Open
Abstract
Now in its centennial year since inauguration, the Department of Surgery at the University of Toronto lays claim to more than 500 faculty, 270 residents, and 250 clinical fellows. There are 7 direct entry residency training programs, and 4 subspecialty programs accredited by the Royal College of Physicians and Surgeons of Canada. There have been 10 chairs of the department since 1921. This article chronicles the life and times of the previous chairs in sequence; the success of the department originates from its many talented and luminary surgeons who have innovated and shaped their fields of surgery. In recent years, the department’s academic productivity has been characterized by more than 1400 peer-reviewed publications per year, and annual research grant capture in excess of $90 million. Since the time of William Gallie, surgical trainees have been enabled to develop careers in surgery and science through the Gallie Program and, more recently, the Surgeon Scientist Training Program (SSTP) to attain higher graduate degrees. Providing quaternary surgical care at multiple hospital sites in Toronto, the Department of Surgery takes great pride in its robust clinical fellowship programs across all specialties that continue to attract trainees from around the world.
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Affiliation(s)
- Robin McLeod
- From the Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Shaf Keshavjee
- From the Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Najma Ahmed
- From the Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Robin Richards
- From the Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Michael G Fehlings
- From the Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Avery Nathens
- From the Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Ori D Rotstein
- From the Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - James T Rutka
- From the Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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26
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Thiong’o GM, Rutka JT. Digital Twin Technology: The Future of Predicting Neurological Complications of Pediatric Cancers and Their Treatment. Front Oncol 2022; 11:781499. [PMID: 35127487 PMCID: PMC8807511 DOI: 10.3389/fonc.2021.781499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022] Open
Abstract
Healthcare technologies have seen a surge in utilization during the COVID 19 pandemic. Remote patient care, virtual follow-up and other forms of futurism will likely see further adaptation both as a preparational strategy for future pandemics and due to the inevitable evolution of artificial intelligence. This manuscript theorizes the healthcare applications of digital twin technology. Digital twin is a triune concept that involves a physical model, a virtual counterpart, and the interplay between the two constructs. This interface between computer science and medicine is a new frontier with broad potential applications. We propose that digital twin technology can exhaustively and methodologically analyze the associations between a physical cancer patient and a corresponding digital counterpart with the goal of isolating predictors of neurological sequalae of disease. This proposition stems from the premise that data science can complement clinical acumen to scientifically inform the diagnostics, treatment planning and prognostication of cancer care. Specifically, digital twin could predict neurological complications through its utilization in precision medicine, modelling cancer care and treatment, predictive analytics and machine learning, and in consolidating various spectra of clinician opinions.
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Affiliation(s)
- Grace M. Thiong’o
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- *Correspondence: Grace M. Thiong’o,
| | - James T. Rutka
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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27
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Rutka JT, Fleshner N, Nathens AB. Re: Jeremy Yuen-Chun Teoh, Daniele Castellani, Claudia Mercader, et al. A Quantitative Analysis Investigating the Prevalence of "Manels" in Major Urology Meetings. Euro Urol 2021;80:442-9. Eur Urol 2021; 81:e51. [PMID: 34872785 DOI: 10.1016/j.eururo.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022]
Affiliation(s)
- James T Rutka
- Division of Neurosurgery, Department of Surgery, Temerty Medicine, University of Toronto, Toronto, Canada.
| | - Neil Fleshner
- Division of Urology, Department of Surgery, Temerty Medicine, University of Toronto, Toronto, Canada
| | - Avery B Nathens
- Division of General Surgery, Department of Surgery, Temerty Medicine, University of Toronto, Toronto, Canada
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28
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Tamura G, Lo WB, Yau I, Vaughan KA, Go C, Singleton WG, Hazon D, Yan H, Otsubo H, Donner EJ, Rutka JT, Ibrahim GM. Patient Characteristics Associated with Seizure Freedom after Vagus Nerve Stimulation in Pediatric Intractable Epilepsy: An Analysis of “Super-Responders”. Journal of Pediatric Epilepsy 2021. [DOI: 10.1055/s-0041-1739489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractClinical responses to vagus nerve stimulation (VNS) therapy for intractable epilepsy can be unpredictable, and factors that predict response to therapy are elusive. Minority of children undergoing VNS achieve seizure freedom. The current study aimed to characterize this exceptional patient population, defined as “super-responders” (SRs). Retrospective data were collected from 150 children who underwent VNS at a single pediatric institution. The patients' mean age at VNS device implantation was 12.0 years (range, 3.09–17.9 years). Ten SRs (6.7%) were identified who achieved and maintained seizure freedom for longer than 1 year following implantation. The interval between epilepsy onset and VNS device implantation was significantly shorter in SRs than in the other children (mean epilepsy duration 5.72 vs. 8.44 years, respectively; p = 0.032). SRs also had a significantly shorter proportion of life with epilepsy compared with the other children (mean ratio of epilepsy duration to age at implantation 0.52 vs. 0.71, respectively; p = 0.023). SRs reported their seizure freedom relatively early (six patients within 6 months and all patients within 12 months after implantation) at relatively low device settings (mean output current 0.81 mA at their last follow-up). Compared with conventional models, responsive VNS models with autostimulation features did not increase the ratio of SRs. No other clinical or imaging characteristic difference between SRs and the other children was found in this cohort. The current study showed a significant association between shorter epilepsy duration and shorter proportion of life with epilepsy and seizure freedom after VNS.
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Affiliation(s)
- Goichiro Tamura
- Division of Neurosurgery, University of Toronto, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Neurosurgery, Ibaraki Children's Hospital, Mito, Ibaraki, Japan
| | - William B. Lo
- Division of Neurosurgery, University of Toronto, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Ivanna Yau
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kerry A. Vaughan
- Division of Neurosurgery, University of Toronto, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cristina Go
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - William G.B. Singleton
- Division of Neurosurgery, University of Toronto, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Hazon
- Division of Neurosurgery, University of Toronto, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Han Yan
- Division of Neurosurgery, University of Toronto, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth J. Donner
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - James T. Rutka
- Division of Neurosurgery, University of Toronto, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George M. Ibrahim
- Division of Neurosurgery, University of Toronto, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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29
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Ha ACT, Bhatt DL, Rutka JT, Johnston SC, Mazer CD, Verma S. Intracranial Hemorrhage During Dual Antiplatelet Therapy: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 78:1372-1384. [PMID: 34556323 DOI: 10.1016/j.jacc.2021.07.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/19/2022]
Abstract
Dual antiplatelet therapy (DAPT) with acetylsalicylic acid and a P2Y12 inhibitor is an established therapy for a broad spectrum of patients with cardiovascular disease. The ischemic benefit of DAPT is partially offset by its increased bleeding risk, with intracranial hemorrhage (ICH) being the most serious complication. Although uncommon (0.2%-0.3% annually), its cumulative burden can be substantial given the number of patients afflicted by cardiovascular disease worldwide. Patients with a history of stroke or transient ischemic attack harbor a particularly high risk for ICH when treated with DAPT. Prediction rules may assist clinicians when weighing the risk/benefit ratio of prescribing DAPT for patients with stroke/transient ischemic attack in the nonacute, ambulatory setting. Currently, there are no reversal agents that can rapidly and effectively reverse the effect of P2Y12 inhibitors in routine practice, although a reversal agent for ticagrelor is under clinical investigation.
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Affiliation(s)
- Andrew C T Ha
- University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts, USA.
| | - James T Rutka
- University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - S Claiborne Johnston
- The Dean's Office, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - C David Mazer
- University of Toronto, Toronto, Ontario, Canada; St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- University of Toronto, Toronto, Ontario, Canada; St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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30
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Rutka JT. Editorial. Neurosurgery training and the One Neurosurgery Summit: all for one, and one for all. J Neurosurg 2021. [PMID: 34359023 DOI: 10.3171/2020.12.jns203671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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31
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Ku JC, Hanak B, Muthusami P, Narvacan K, Girgis H, terBrugge K, Krings T, Rutka JT, Dirks P. Improving long-term outcomes in pediatric torcular dural sinus malformations with embolization and anticoagulation: a retrospective review of The Hospital for Sick Children experience. J Neurosurg Pediatr 2021; 28:469-475. [PMID: 34330098 DOI: 10.3171/2021.3.peds20921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Torcular dural sinus malformations (tDSMs) are rare pediatric cerebrovascular malformations characterized by giant venous lakes localized to the midline confluence of sinuses. Historical clinical outcomes of patients with these lesions were poor, though better prognoses have been reported in the more recent literature. Long-term outcomes in children with tDSMs are uncertain and require further characterization. The goal of this study was to review a cohort of tDSM patients with an emphasis on long-term outcomes and to describe the treatment strategy. METHODS This study is a single-center retrospective review of a prospectively maintained data bank including patients referred to and cared for at The Hospital for Sick Children for tDSM from January 1996 to March 2019. Each patient's clinical, radiological, and demographic information, as well as their mother's demographic information, was collected for review. RESULTS Ten patients with tDSM, with a mean follow-up of 58 months, were included in the study. Diagnoses were made antenatally in 8 patients, and among those cases, 4 families opted for either elective termination (n = 1) or no further care following delivery (n = 3). Of the 6 patients treated, 5 had a favorable long-term neurological outcome, and follow-up imaging demonstrated a decrease or stability in the size of the tDSM over time. Staged embolization was performed in 3 patients, and anticoagulation was utilized in 5 treated patients. CONCLUSIONS The authors add to a growing body of literature indicating that clinical outcomes in tDSM may not be as poor as initially perceived. Greater awareness of the lesion's natural history and pathophysiology, advancing endovascular techniques, and individualized anticoagulation regimens may lead to continued improvement in outcomes.
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Affiliation(s)
- Jerry C Ku
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Brian Hanak
- 3Department of Neurosurgery, Loma Linda University Health, Loma Linda, California
| | - Prakash Muthusami
- 4Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto
| | - Karl Narvacan
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Hidy Girgis
- 5Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa
| | - Karel terBrugge
- 4Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto.,6Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; and
| | - Timo Krings
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto.,4Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto.,6Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; and
| | - James T Rutka
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Peter Dirks
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
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Hamidi N, Karmur B, Sperrazza S, Alexieva J, Salmi L, Zacharia BE, Nduom EK, Cohen-Gadol AA, Rutka JT, Mansouri A. Guidelines for optimal utilization of social media for brain tumor stakeholders. J Neurosurg 2021; 136:335-342. [PMID: 34298513 DOI: 10.3171/2020.11.jns203226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Effective use of social media (SM) by medical professionals is vital for better connections with patients and dissemination of evidence-based information. A study of SM utilization by different stakeholders in the brain tumor community may help determine guidelines for optimal use. METHODS Facebook, Twitter, and YouTube were searched by using the term "Brain Tumor." Platform-specific metrics were determined, including audience size, as a measure of popularity, and mean annual increase in audience size, as a measure of performance on SM. Accounts were categorized on the basis of apparent ownership and content, with as many as two qualitative themes assigned to each account. Correlations of content themes and posting behavior with popularity and performance metrics were assessed by using the Pearson's test. RESULTS Facebook (67 pages and 304,581 likes) was predominantly used by organizations (64% of pages). Top themes on Facebook, Twitter, and YouTube were charity and fundraising (67% of pages), education and research (72% of accounts), and experience sharing and support seeking (48% of videos, 60% of views, and 82% of user engagement), respectively. On Facebook, only the presence of other concurrent platforms influenced a page's performance (rho = 0.59) and popularity (rho = 0.61) (p < 0.05). On Twitter, the number of monthly tweets (rho = 0.66) and media utilization (rho = 0.78) were significantly correlated with increased popularity and performance (both p < 0.05). Personal YouTube videos (30% of videos and 61% of views) with the theme of experience sharing and support seeking had the highest level of engagement (60% of views, 70% of comments, and 87% of likes). CONCLUSIONS Popularity and prevalence of qualitative themes differ among SM platforms. Thus, optimal audience engagement on each platform can be achieved with thematic considerations. Such considerations, along with optimal SM behavior such as media utilization and multiplatform presence, may help increase content popularity and thus increase community access to neurooncology content provided by medical professionals.
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Affiliation(s)
- Nima Hamidi
- 1Arizona College of Osteopathic Medicine, Glendale, Arizona
| | - Brij Karmur
- 2Section of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | | | - Julia Alexieva
- 1Arizona College of Osteopathic Medicine, Glendale, Arizona
| | - Liz Salmi
- 6Department of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brad E Zacharia
- 7Department of Neurosurgery, Penn State University, Hershey; and.,8Penn State Cancer Institute, Hershey, Pennsylvania
| | | | | | - James T Rutka
- 5Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Alireza Mansouri
- 7Department of Neurosurgery, Penn State University, Hershey; and.,8Penn State Cancer Institute, Hershey, Pennsylvania
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Air EL, Orrico KO, Benzil DL, Scarrow AM, Bean JR, Mazzola CA, Liau LM, Rutka JT, Muraszko KM. Developing a Professionalism and Harassment Policy for Organized Neurosurgery. Neurosurgery 2021; 88:1038-1039. [PMID: 33755153 PMCID: PMC8046587 DOI: 10.1093/neuros/nyab051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/26/2020] [Indexed: 11/13/2022] Open
Abstract
Annual conferences, educational courses, and other meetings draw a diverse community of individuals, yet also create a unique environment without the traditional guard rails. Unlike events held at one's home institution, clear rules and jurisdiction have not been universally established. To promote the open exchange of ideas, as well as an environment conducive to professional growth of all participants, the leading neurosurgical professional organizations joined forces to delineate the expectations for anyone who participates in sponsored events. The One Neurosurgery Summit Taskforce on Professionalism and Harassment developed a foundational policy that establishes common expectations for behavior and a unified roadmap for the prompt response to untoward events. We hope that publishing this policy will inspire other medical organizations to establish their own meeting and conference policies. More importantly, we wish to bring greater attention to everyone's responsibility for ensuring a safe and respectful space for education, scientific debate, and networking during organized events.
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Affiliation(s)
- Ellen L Air
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Katie O Orrico
- Washington Office, American Association of Neurological Surgeons/ Congress of Neurological Surgeons, Washington, District of Columbia, USA
| | - Deborah L Benzil
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - James R Bean
- Baptist Health Lexington, Lexington, Kentucky, USA
| | | | - Linda M Liau
- Department of Neurosurgery, David Geffen School of Medicine, UCLA Health, University of California at Los Angeles, Los Angeles, California, USA
| | - James T Rutka
- Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada.,Chair of the Professionalism and Harassment Taskforce
| | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.,Chair of the Professionalism and Harassment Taskforce
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Roth J, Constantini S, Ekstein M, Weiner HL, Tripathi M, Chandra PS, Cossu M, Rizzi M, Bollo RJ, Machado HR, Santos MV, Keating RF, Oluigbo CO, Rutka JT, Drake JM, Jallo GI, Shimony N, Treiber JM, Consales A, Mangano FT, Wisoff JH, Teresa Hidalgo E, Bingaman WE, Gupta A, Erdemir G, Sundar SJ, Benifla M, Shapira V, Lam SK, Fallah A, Maniquis CAB, Tisdall M, Chari A, Cinalli G, Blount JP, Dorfmüller G, Christine Bulteau, Uliel-Sibony S. Epilepsy surgery in infants up to 3 months of age: Safety, feasibility, and outcomes: A multicenter, multinational study. Epilepsia 2021; 62:1897-1906. [PMID: 34128544 DOI: 10.1111/epi.16959] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Drug-resistant epilepsy (DRE) during the first few months of life is challenging and necessitates aggressive treatment, including surgery. Because the most common causes of DRE in infancy are related to extensive developmental anomalies, surgery often entails extensive tissue resections or disconnection. The literature on "ultra-early" epilepsy surgery is sparse, with limited data concerning efficacy controlling the seizures, and safety. The current study's goal is to review the safety and efficacy of ultra-early epilepsy surgery performed before the age of 3 months. METHODS To achieve a large sample size and external validity, a multinational, multicenter retrospective study was performed, focusing on epilepsy surgery for infants younger than 3 months of age. Collected data included epilepsy characteristics, surgical details, epilepsy outcome, and complications. RESULTS Sixty-four patients underwent 69 surgeries before the age of 3 months. The most common pathologies were cortical dysplasia (28), hemimegalencephaly (17), and tubers (5). The most common procedures were hemispheric surgeries (48 procedures). Two cases were intentionally staged, and one was unexpectedly aborted. Nearly all patients received blood products. There were no perioperative deaths and no major unexpected permanent morbidities. Twenty-five percent of patients undergoing hemispheric surgeries developed hydrocephalus. Excellent epilepsy outcome (International League Against Epilepsy [ILAE] grade I) was achieved in 66% of cases over a median follow-up of 41 months (19-104 interquartile range [IQR]). The number of antiseizure medications was significantly reduced (median 2 drugs, 1-3 IQR, p < .0001). Outcome was not significantly associated with the type of surgery (hemispheric or more limited resections). SIGNIFICANCE Epilepsy surgery during the first few months of life is associated with excellent seizure control, and when performed by highly experienced teams, is not associated with more permanent morbidity than surgery in older infants. Thus surgical treatment should not be postponed to treat DRE in very young infants based on their age.
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Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Margaret Ekstein
- Pediatric Anesthesia Unit, Department of Anesthesia, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Howard L Weiner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.,Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Manjari Tripathi
- Center of Excellence for Epilepsy and MEG, AIIMS, New Delhi, India
| | | | - Massimo Cossu
- "C. Munari" Centre for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Michele Rizzi
- "C. Munari" Centre for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Robert J Bollo
- Division of Pediatric Neurosurgery, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Hélio Rubens Machado
- Pediatric Neurosurgery, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Marcelo Volpon Santos
- Pediatric Neurosurgery, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Robert F Keating
- Department of Neurosurgery, Children's National Medical Center, Washington, DC, USA
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Medical Center, Washington, DC, USA
| | - James T Rutka
- Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - James M Drake
- Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - George I Jallo
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania, USA
| | - Jeffrey M Treiber
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.,Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Alessandro Consales
- Department of Pediatric Neurosurgery, IRRCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesco T Mangano
- Department of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey H Wisoff
- Division of Pediatric Neurosurgery, Hassenfeld Children's Hospital, NYU Langone Health, New York, NY, USA
| | - Eveline Teresa Hidalgo
- Division of Pediatric Neurosurgery, Hassenfeld Children's Hospital, NYU Langone Health, New York, NY, USA
| | - William E Bingaman
- Department of Neurological Surgery, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Ajay Gupta
- Department of Neurology, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Gozde Erdemir
- Department of Neurology, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Swetha J Sundar
- Department of Neurological Surgery, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Mony Benifla
- Pediatric Neurosurgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Vladimir Shapira
- Pediatric Neurosurgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Sandi K Lam
- Department of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Cassia A B Maniquis
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital & Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital & Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Al, USA
| | - Georg Dorfmüller
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France
| | - Christine Bulteau
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France.,MC2Lab, University of Paris, Boulogne-Billancourt, France
| | - Shimrit Uliel-Sibony
- Pediatric Neurology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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Shahzad U, Taccone MS, Kumar SA, Okura H, Krumholtz S, Ishida J, Mine C, Gouveia K, Edgar J, Smith C, Hayes M, Huang X, Derry WB, Taylor MD, Rutka JT. Modeling human brain tumors in flies, worms, and zebrafish: From proof of principle to novel therapeutic targets. Neuro Oncol 2021; 23:718-731. [PMID: 33378446 DOI: 10.1093/neuonc/noaa306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
For decades, cell biologists and cancer researchers have taken advantage of non-murine species to increase our understanding of the molecular processes that drive normal cell and tissue development, and when perturbed, cause cancer. The advent of whole-genome sequencing has revealed the high genetic homology of these organisms to humans. Seminal studies in non-murine organisms such as Drosophila melanogaster, Caenorhabditis elegans, and Danio rerio identified many of the signaling pathways involved in cancer. Studies in these organisms offer distinct advantages over mammalian cell or murine systems. Compared to murine models, these three species have shorter lifespans, are less resource intense, and are amenable to high-throughput drug and RNA interference screening to test a myriad of promising drugs against novel targets. In this review, we introduce species-specific breeding strategies, highlight the advantages of modeling brain tumors in each non-mammalian species, and underscore the successes attributed to scientific investigation using these models. We conclude with an optimistic proposal that discoveries in the fields of cancer research, and in particular neuro-oncology, may be expedited using these powerful screening tools and strategies.
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Affiliation(s)
- Uswa Shahzad
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Michael S Taccone
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Sachin A Kumar
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Hidehiro Okura
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Stacey Krumholtz
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Joji Ishida
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Coco Mine
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Kyle Gouveia
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Julia Edgar
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Christian Smith
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Madeline Hayes
- Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, Canada
| | - Xi Huang
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada.,Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, Canada
| | - W Brent Derry
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Michael D Taylor
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - James T Rutka
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
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36
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Fukuoka K, Mamatjan Y, Tatevossian R, Zapotocky M, Ryall S, Stucklin AG, Bennett J, Nobre LF, Arnoldo A, Luu B, Wen J, Zhu K, Leon A, Torti D, Pugh TJ, Hazrati LN, Laperriere N, Drake J, Rutka JT, Dirks P, Kulkarni AV, Taylor MD, Bartels U, Huang A, Zadeh G, Aldape K, Ramaswamy V, Bouffet E, Snuderl M, Ellison D, Hawkins C, Tabori U. Clinical impact of combined epigenetic and molecular analysis of pediatric low-grade gliomas. Neuro Oncol 2021; 22:1474-1483. [PMID: 32242226 DOI: 10.1093/neuonc/noaa077] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Both genetic and methylation analysis have been shown to provide insight into the diagnosis and prognosis of many brain tumors. However, the implication of methylation profiling and its interaction with genetic alterations in pediatric low-grade gliomas (PLGGs) are unclear. METHODS We performed a comprehensive analysis of PLGG with long-term clinical follow-up. In total 152 PLGGs were analyzed from a range of pathological subtypes, including 40 gangliogliomas. Complete molecular analysis was compared with genome-wide methylation data and outcome in all patients. For further analysis of specific PLGG groups, including BRAF p.V600E mutant gliomas, we compiled an additional cohort of clinically and genetically defined tumors from 3 large centers. RESULTS Unsupervised hierarchical clustering revealed 5 novel subgroups of PLGG. These were dominated by nonneoplastic factors such as tumor location and lymphocytic infiltration. Midline PLGG clustered together while deep hemispheric lesions differed from lesions in the periphery. Mutations were distributed throughout these location-driven clusters of PLGG. A novel methylation cluster suggesting high lymphocyte infiltration was confirmed pathologically and exhibited worse progression-free survival compared with PLGG harboring similar molecular alterations (P = 0.008; multivariate analysis: P = 0.035). Although the current methylation classifier revealed low confidence in 44% of cases and failed to add information in most PLGG, it was helpful in reclassifying rare cases. The addition of histopathological and molecular information to specific methylation subgroups such as pleomorphic xanthoastrocytoma-like tumors could stratify these tumors into low and high risk (P = 0.0014). CONCLUSION The PLGG methylome is affected by multiple nonneoplastic factors. Combined molecular and pathological analysis is key to provide additional information when methylation classification is used for PLGG in the clinical setting.
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Affiliation(s)
- Kohei Fukuoka
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yasin Mamatjan
- Princess Margaret Cancer Centre and MacFeeters-Hamilton Centre for Neuro-Oncology Research, Toronto, Ontario, Canada
| | - Ruth Tatevossian
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Michal Zapotocky
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Scott Ryall
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Ana Guerreiro Stucklin
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Deparment of Oncology and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Julie Bennett
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Liana Figueiredo Nobre
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anthony Arnoldo
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Betty Luu
- Program in Developmental and Stem Cell Biology, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ji Wen
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kaicen Zhu
- Department of Pathology, New York University Langone Health and Medical Center, New York, New York, USA
| | - Alberto Leon
- PM-OICR Translational Genomics Laboratory, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Dax Torti
- PM-OICR Translational Genomics Laboratory, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Trevor J Pugh
- PM-OICR Translational Genomics Laboratory, Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Lili-Naz Hazrati
- Division of Pathology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Normand Laperriere
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - James Drake
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Dirks
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Abhaya V Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael D Taylor
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ute Bartels
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Annie Huang
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Princess Margaret Cancer Centre and MacFeeters-Hamilton Centre for Neuro-Oncology Research, Toronto, Ontario, Canada
| | - Kenneth Aldape
- Princess Margaret Cancer Centre and MacFeeters-Hamilton Centre for Neuro-Oncology Research, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matija Snuderl
- Department of Pathology, New York University Langone Health and Medical Center, New York, New York, USA
| | - David Ellison
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Cynthia Hawkins
- Division of Pathology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Uri Tabori
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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Air EL, Orrico KO, Benzil DL, Scarrow AM, Bean JR, Mazzola CA, Liau LM, Rutka JT, Muraszko KM. Developing a professionalism and harassment policy for organized neurosurgery. J Neurosurg 2021; 134:1355-1356. [PMID: 33761456 DOI: 10.3171/2021.1.jns218000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Annual conferences, educational courses, and other meetings draw a diverse community of individuals, yet also create a unique environment without the traditional guard rails. Unlike events held at one's home institution, clear rules and jurisdiction have not been universally established. To promote the open exchange of ideas, as well as an environment conducive to professional growth of all participants, the leading neurosurgical professional organizations joined to delineate the expectations for anyone who participates in sponsored events. The One Neurosurgery Summit Taskforce on Professionalism and Harassment developed a foundational policy that establishes common expectations for behavior and a unified roadmap for the prompt response to untoward events. We hope that publishing this policy will inspire other medical organizations to establish their own meeting and conference policies. More importantly, we wish to bring greater attention to everyone's responsibility for ensuring a safe and respectful space for education, scientific debate, and networking during organized events.
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Affiliation(s)
- Ellen L Air
- 1Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Katie O Orrico
- 2Washington Office, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Washington, District of Columbia, USA
| | - Deborah L Benzil
- 3Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - James R Bean
- 5Baptist Health Lexington, Lexington, Kentucky, USA
| | | | - Linda M Liau
- 7Department of Neurosurgery, David Geffen School of Medicine, UCLA Health, University of California at Los Angeles, Los Angeles, California, USA
| | - James T Rutka
- 8Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada.,10Chair of the Professionalism and Harassment Taskforce
| | - Karin M Muraszko
- 9Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.,10Chair of the Professionalism and Harassment Taskforce
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38
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Suzuki H, Otsubo H, Yokota N, Nishijima S, Go C, Carter Snead O, Ochi A, Rutka JT, Moharir M. Epileptogenic modulation index and synchronization in hypsarrhythmia of West syndrome secondary to perinatal arterial ischemic stroke. Clin Neurophysiol 2021; 132:1185-1193. [PMID: 33674213 DOI: 10.1016/j.clinph.2020.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Perinatal arterial ischemic stroke (PAIS) is associated with epileptic spasms of West syndrome (WS) and long term Focal epilepsy (FE). The mechanism of epileptogenic network generation causing hypsarrhythmia of WS is unknown. We hypothesized that Modulation index (MI) [strength of phase-amplitude coupling] and Synchronization likelihood (SL) [degree of connectivity] could interrogate the epileptogenic network in hypsarrhythmia of WS secondary to PAIS. METHODS We analyzed interictal scalp electroencephalography (EEG) in 10 WS and 11 FE patients with unilateral PAIS. MI between gamma (30-70 Hz) and slow waves (3-4 Hz) was calculated to measure phase-amplitude coupling. SL between electrode pairs was analyzed in 9-frequency bands (5-delta, theta, alpha, beta, gamma) to examine inter- and intra-hemispheric connectivity. RESULTS MI was higher in affected hemispheres in WS (p = 0.006); no differences observed in FE. Inter-hemispheric SL of 3-delta, theta, alpha, beta, gamma bands was significantly higher in WS (p < 0.001). In WS, modified Z-Score of intra-hemispheric SL values in 3-delta, theta, alpha, beta and gamma in the affected hemispheres were significantly higher than those in the unaffected hemispheres (p < 0.001) as well as 0.5-4 Hz (p = 0.004). CONCLUSIONS The significantly higher modulation in affected hemisphere and stronger inter- and intra-hemispheric connectivity generate hypsarrhythmia of WS secondary to PAIS. SIGNIFICANCE Epileptogenic cortical-subcortical transcallosal networks from affected hemisphere post-PAIS provokes infantile spasms.
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Affiliation(s)
- Hiroharu Suzuki
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Neurosurgery, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Hiroshi Otsubo
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Nanako Yokota
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Sakura Nishijima
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Cristina Go
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - O Carter Snead
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Ayako Ochi
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - James T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Mahendranath Moharir
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Children's Stroke Program, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
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Woolman M, Katz L, Gopinath G, Kiyota T, Kuzan-Fischer CM, Ferry I, Zaidi M, Peters K, Aman A, McKee T, Fu F, Amara-Belgadi S, Daniels C, Wouters BG, Rutka JT, Ginsberg HJ, McIntosh C, Zarrine-Afsar A. Mass Spectrometry Imaging Reveals a Gradient of Cancer-like Metabolic States in the Vicinity of Cancer Not Seen in Morphometric Margins from Microscopy. Anal Chem 2021; 93:4408-4416. [PMID: 33651938 DOI: 10.1021/acs.analchem.0c04129] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Spatially resolved ambient mass spectrometry imaging methods have gained popularity to characterize cancer sites and their borders using molecular changes in the lipidome. This utility, however, is predicated on metabolic homogeneity at the border, which would create a sharp molecular transition at the morphometric borders. We subjected murine models of human medulloblastoma brain cancer to mass spectrometry imaging, a technique that provides a direct readout of tissue molecular content in a spatially resolved manner. We discovered a distance-dependent gradient of cancer-like lipid molecule profiles in the brain tissue within 1.2 mm of the cancer border, suggesting that a cancer-like state progresses beyond the histologic border, into the healthy tissue. The results were further corroborated using orthogonal liquid chromatography and mass spectrometry (LC-MS) analysis of selected tissue regions subjected to laser capture microdissection. LC-MS/MS analysis for robust identification of the affected molecules implied changes in a number of different lipid classes, some of which are metabolized from the essential docosahexaenoic fatty acid (DHA) present in the interstitial fluid. Metabolic molecular borders are thus not as sharp as morphometric borders, and mass spectrometry imaging can reveal molecular nuances not observed with microscopy. Caution must be exercised in interpreting multimodal imaging results stipulated on a coincidental relationship between metabolic and morphometric borders of cancer, at least within animal models used in preclinical research.
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Affiliation(s)
- Michael Woolman
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Toronto, Ontario M5G 1P5, Canada.,Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Lauren Katz
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Toronto, Ontario M5G 1P5, Canada.,Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Georgia Gopinath
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Toronto, Ontario M5G 1P5, Canada.,Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Taira Kiyota
- Drug Discovery Program, Ontario Institute for Cancer Research, 661 University Avenue, Toronto, Ontario M5G 0A3, Canada
| | - Claudia M Kuzan-Fischer
- Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Developmental & Stem Cell Biology Program, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada
| | - Isabelle Ferry
- Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Developmental & Stem Cell Biology Program, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada
| | - Mark Zaidi
- Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada.,STTARR Innovation Centre, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Kaitlyn Peters
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Toronto, Ontario M5G 1P5, Canada.,Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Ahmed Aman
- Drug Discovery Program, Ontario Institute for Cancer Research, 661 University Avenue, Toronto, Ontario M5G 0A3, Canada.,Leslie Dan Faculty of Pharmacy, 144 College Street, Toronto, Ontario M5S 3M2, Canada
| | - Trevor McKee
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Toronto, Ontario M5G 1P5, Canada.,STTARR Innovation Centre, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Fred Fu
- STTARR Innovation Centre, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Siham Amara-Belgadi
- Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Craig Daniels
- Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Developmental & Stem Cell Biology Program, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada
| | - Brad G Wouters
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Toronto, Ontario M5G 1P5, Canada.,Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - James T Rutka
- Department of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada.,Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Howard J Ginsberg
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Toronto, Ontario M5G 1P5, Canada.,Department of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada.,Keenan Research Center for Biomedical Science & The Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada
| | - Chris McIntosh
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Toronto, Ontario M5G 1P5, Canada.,Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada.,Peter Munk Cardiac Centre, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario M5G 2N2, Canada.,Vector Institute for Artificial Intelligence, Toronto, Ontario M5G 1M1, Canada
| | - Arash Zarrine-Afsar
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Toronto, Ontario M5G 1P5, Canada.,Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada.,Department of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada.,Keenan Research Center for Biomedical Science & The Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
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40
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Veilleux C, Samuel N, Yan H, Bass V, Al-Shahrani R, Mansur A, Rutka JT, Zadeh G, Hodaie M, Milot G. Cross-sectional analysis of women in neurosurgery: a Canadian perspective. Neurosurg Focus 2021; 50:E13. [PMID: 33789236 DOI: 10.3171/2020.12.focus20959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although the past decades have seen a steady increase of women in medicine in general, women continue to represent a minority of the physician-training staff and workforce in neurosurgery in Canada and worldwide. As such, the aim of this study was to analyze the experiences of women faculty practicing neurosurgery across Canada to better understand and address the factors contributing to this disparity. METHODS A historical, cross-sectional, and mixed-method analysis of survey responses was performed using survey results obtained from women attending neurosurgeons across Canada. A web-based survey platform was utilized to collect responses. Quantitative analyses were performed on the responses from the study questionnaire, including summary and comparative statistics. Qualitative analyses of free-text responses were performed using axial and open coding. RESULTS A total of 19 of 31 respondents (61.3%) completed the survey. Positive enabling factors for career success included supportive colleagues and work environment (52.6%); academic accomplishments, including publications and advanced degrees (36.8%); and advanced fellowship training (47.4%). Perceived barriers reported included inequalities with regard to career advancement opportunities (57.8%), conflicting professional and personal interests (57.8%), and lack of mentorship (36.8%). Quantitative analyses demonstrated emerging themes of an increased need for women mentors as well as support and recognition of the contributions to career advancement of personal and family-related factors. CONCLUSIONS This study represents, to the authors' knowledge, the first analysis of factors influencing career success and satisfaction in women neurosurgeons across Canada. This study highlights several key factors contributing to the low representation of women in neurosurgery and identifies specific actionable items that can be addressed by training programs and institutions. In particular, female mentorship, opportunities for career advancement, and increased recognition and integration of personal and professional roles were highlighted as areas for future intervention. These findings will provide a framework for addressing these factors and improving the recruitment and retention of females in this specialty.
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Affiliation(s)
- Catherine Veilleux
- 1Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Alberta
| | - Nardin Samuel
- 2Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario
| | - Han Yan
- 2Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario
| | - Victoria Bass
- 3Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario; and
| | - Rabab Al-Shahrani
- 2Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario
| | - Ann Mansur
- 2Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario
| | - James T Rutka
- 2Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario
| | - Gelareh Zadeh
- 2Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario
| | - Mojgan Hodaie
- 2Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario
| | - Geneviève Milot
- 4Department of Surgery (Neurosurgery), Université Laval, Québec City, Québec, Canada
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Srikanthan D, Taccone MS, Van Ommeren R, Ishida J, Krumholtz SL, Rutka JT. Diffuse intrinsic pontine glioma: current insights and future directions. Chin Neurosurg J 2021; 7:6. [PMID: 33423692 PMCID: PMC7798267 DOI: 10.1186/s41016-020-00218-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a lethal pediatric brain tumor and the leading cause of brain tumor–related death in children. As several clinical trials over the past few decades have led to no significant improvements in outcome, the current standard of care remains fractionated focal radiation. Due to the recent increase in stereotactic biopsies, tumor tissue availabilities have enabled our advancement of the genomic and molecular characterization of this lethal cancer. Several groups have identified key histone gene mutations, genetic drivers, and methylation changes in DIPG, providing us with new insights into DIPG tumorigenesis. Subsequently, there has been increased development of in vitro and in vivo models of DIPG which have the capacity to unveil novel therapies and strategies for drug delivery. This review outlines the clinical characteristics, genetic landscape, models, and current treatments and hopes to shed light on novel therapeutic avenues and challenges that remain.
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Affiliation(s)
- Dilakshan Srikanthan
- Cell Biology Program, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Michael S Taccone
- Cell Biology Program, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Randy Van Ommeren
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Developmental and Stem Cell Biology Program, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Joji Ishida
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Stacey L Krumholtz
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - James T Rutka
- Cell Biology Program, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada. .,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada. .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada. .,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada. .,Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Suite 1503, 555, University Avenue, Toronto, ON, M5G 1X8, Canada.
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Lohkamp LN, Kulkarni A, Drake J, Rutka JT, Dirks P, Taylor M, Ibrahim G, Baroni L, Hamilton J, Bartels UK. RARE-09. PRESERVATION OF ENDOCRINE FUNCTION AFTER OMMAYA RESERVOIR INSERTION IN CHILDREN WITH CYSTIC CRANIOPHARYNGIOMA. Neuro Oncol 2020. [PMCID: PMC7715384 DOI: 10.1093/neuonc/noaa222.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Children with craniopharyngiomas (CP) can be subjected to significant morbidities caused by radical surgery and/or radiation with severe long-term consequences. Ommaya reservoir Insertion (ORI) into cystic CP represents a minimally invasive procedure that aims to preserve endocrine, hypothalamic and neurocognitive function. The purpose of this study was to determine the relevance of upfront ORI (+/- intracystic treatment) for preservation of endocrine function. METHODS A retrospective chart review of children with CP treated at the Hospital for Sick Children between 01/01/2000 and 15/01/2020 was undertaken. Endocrine function was reviewed at the time of initial ORI or surgical resection and throughout the course of follow-up. Event free survival (EFS) was defined as the time to additional surgical resection or irradiation. RESULTS Fifty-five patients with sufficient endocrine follow-up data were included. The median age of diagnosis was 8.3 years (range 2.1–18.0 years), 31 were males. ORI was performed as upfront treatment in 30 patients, gross total or partial resection in 24 patients and radiation in 1 patient, respectively. Endocrine function remained stable after ORI with a median EFS of 19.2 (0 – 105.3) months while the majority of patients who underwent surgical resection had documented worsened endocrine function postoperatively (median of 0; range 0 – 29.4 months) (p< 0.001). The event most commonly related to secondary endocrine deterioration was initial or delayed surgical resection. CONCLUSIONS Endocrine function was preserved in patients with upfront ORI (+/- intracystic treatment). Further studies will elucidate the implications of ORI with respect to ophthalmological, vascular and neurocognitive long-term outcome.
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Affiliation(s)
- Laura-Nanna Lohkamp
- The Hospital for Sick Children, Division of Neurosurgery, Toronto, ON, Canada
| | - Abhaya Kulkarni
- The Hospital for Sick Children, Division of Neurosurgery, Toronto, ON, Canada
| | - James Drake
- The Hospital for Sick Children, Division of Neurosurgery, Toronto, ON, Canada
| | - James T Rutka
- The Hospital for Sick Children, Division of Neurosurgery, Toronto, ON, Canada
| | - Peter Dirks
- The Hospital for Sick Children, Division of Neurosurgery, Toronto, ON, Canada
| | - Michael Taylor
- The Hospital for Sick Children, Division of Neurosurgery, Toronto, ON, Canada
| | - George Ibrahim
- The Hospital for Sick Children, Division of Neurosurgery, Toronto, ON, Canada
| | - Lorena Baroni
- The Hospital for Sick Children, Division of Haematology/Oncology, Toronto, ON, Canada
| | - Jill Hamilton
- The Hospital for Sick Children, Division of Endocrinology, Toronto, ON, Canada
| | - Ute Katharina Bartels
- The Hospital for Sick Children, Division of Haematology/Oncology, Toronto, ON, Canada
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Benzil DL, Muraszko KM, Soni P, Air EL, Orrico KO, Rutka JT. Toward an understanding of sexual harassment in neurosurgery. J Neurosurg 2020:1-10. [PMID: 33171438 DOI: 10.3171/2020.6.jns201649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was the creation and administration of a survey to assess the depth and breadth of sexual harassment across neurosurgery. METHODS A survey was created to 1) assess perceived attitudes toward systemic issues that might be permissive of sexual harassment; 2) measure the reported prevalence and severity of sexual harassment; and 3) determine the populations at highest risk and those most likely to perpetrate sexual harassment. Demographic information was also included to facilitate further analysis. The SurveyMonkey platform was used, and a request to complete the survey was sent to all Society of Neurological Surgeons and Congress of Neurological Surgeons (CNS) active and resident members as well as CNS transitional, emeritus, and inactive members. Data were analyzed using RStudio version 1.2.5019. RESULTS Nearly two-thirds of responders indicated having witnessed sexual harassment in some form (62%, n = 382). Males were overwhelmingly identified as the offenders in allegations of sexual harassment (72%), with individuals in a "superior position" identified as offenders in 86%. Less than one-third of responders addressed the incidents of sexual harassment when they happened (yes 31%, no 62%, unsure 7%). Of those who did report, most felt there was either no impact or a negative one (negative: 34%, no impact: 38%). Almost all (85%) cited barriers to taking action about sexual harassment, including retaliation/retribution (87%), impact on future career (85%), reputation concerns (72%), and associated stress (50%). Female neurosurgeons were statistically more likely than male neurosurgeons to report witnessing or experiencing sexual harassment, as well as assessing it as a problem. CONCLUSIONS This study demonstrates that neurosurgeons report significant sexual harassment across all ages and practice settings. Sexual harassment impacts both men and women, with more than half personally subjected to this behavior and two-thirds having witnessed it. Male dominance, a hierarchical environment, and a permissive environment remain prevalent within the neurosurgical community. This is not just a historical problem, but it continues today. A change of culture will be required for neurosurgery to shed this mantle, which must include zero tolerance of this behavior, new policies, awareness of unconscious bias, and commitment to best practices to enhance diversity. Above all, it will require that all neurosurgeons and neurosurgical leaders develop an awareness of sexual harassment in the workplace and establish consistent mechanisms to mitigate against its highly deleterious effects in the specialty.
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Affiliation(s)
| | - Karin M Muraszko
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Pranay Soni
- 1Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Ellen L Air
- 3Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Katie O Orrico
- 4Washington Office, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Washington, DC; and
| | - James T Rutka
- 5Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada
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Hadjinicolaou A, Jain P, Arya R, Roth C, Whitney R, Yau I, Greiner HM, Mangano FT, Rutka JT, Go C. Generator replacement with cardiac-based VNS device in children with drug-resistant epilepsy: An observational study. Epilepsy Res 2020; 167:106431. [DOI: 10.1016/j.eplepsyres.2020.106431] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/02/2020] [Accepted: 07/14/2020] [Indexed: 11/24/2022]
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45
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Cho N, Nga VDW, Ahmed R, Ku JC, Munarriz PM, Muthusami P, Rutka JT, Dirks P. Surgical management of pediatric rolandic arteriovenous malformations: a single-center case series. J Neurosurg Pediatr 2020; 27:62-68. [PMID: 33126222 DOI: 10.3171/2020.6.peds18547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pediatric rolandic arteriovenous malformations (AVMs) present a treatment challenge given the lifetime risk of hemorrhage, rehemorrhage, and associated long-term morbidity. Microsurgical resection has been recommended as the optimal treatment for AVMs in general, but there is no dedicated literature on the outcomes of resection of pediatric rolandic AVMs. Here, the study objective was to review the outcomes of microsurgical resection of pediatric rolandic AVMs in the modern era, together with the utilization of surgical adjuncts including navigation, intraoperative angiography, and neurophysiological monitoring. METHODS The authors performed a retrospective review of patients 18 years of age and younger with cerebral AVMs microsurgically treated between January 2000 and May 2016 at The Hospital for Sick Children. Only those patients with an AVM whose nidus was located within the rolandic region were analyzed. A descriptive analysis was performed to identify patient demographics, preoperative AVM characteristics, and postoperative obliteration rates and neurological complications. RESULTS A total of 279 AVMs were evaluated in the study period. Twenty-three of these AVMs were rolandic, and the median age in the 11 microsurgically treated cases was 11 years (range 1-17 years). AVM hemorrhage was the most common presentation, occurring in 8 patients (73%). Lesions were either Spetzler-Martin grade II (n = 8, 73%) or grade III (n = 3, 27%). The postoperative obliteration rate of AVMs was 100%. The mean imaging follow-up duration was 33 months (range 5-164 months). There was no documented recurrence of an AVM during follow-up. One patient developed a transient postoperative hemiparesis, while another patient developed right fingertip hyperesthesia. CONCLUSIONS Microsurgical resection of rolandic pediatric AVMs yields excellent AVM obliteration with minimal neurological morbidity in selected patients. The incorporation of surgical adjuncts, including neurophysiological monitoring and neuronavigation, allows accurate demarcation of functional cortex and enables effective resection.
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Affiliation(s)
- Newton Cho
- 1The Hospital for Sick Children, Toronto.,Departments of2Neurosurgery and
| | - Vincent D W Nga
- 3Department of Neurosurgery, National Hospital of Singapore, Singapore; and
| | - Raheel Ahmed
- 4Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Jerry C Ku
- 1The Hospital for Sick Children, Toronto.,Departments of2Neurosurgery and
| | - Pablo M Munarriz
- 1The Hospital for Sick Children, Toronto.,Departments of2Neurosurgery and
| | - Prakash Muthusami
- 1The Hospital for Sick Children, Toronto.,5Neuroradiology, University of Toronto, Toronto, Ontario, Canada
| | - James T Rutka
- 1The Hospital for Sick Children, Toronto.,Departments of2Neurosurgery and
| | - Peter Dirks
- 1The Hospital for Sick Children, Toronto.,Departments of2Neurosurgery and
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Wong R, Gong H, Alanazi R, Bondoc A, Luck A, Sabha N, Horgen FD, Fleig A, Rutka JT, Feng ZP, Sun HS. Inhibition of TRPM7 with waixenicin A reduces glioblastoma cellular functions. Cell Calcium 2020; 92:102307. [PMID: 33080445 DOI: 10.1016/j.ceca.2020.102307] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/27/2020] [Accepted: 10/04/2020] [Indexed: 12/28/2022]
Abstract
Glioblastoma (GBM) is the most common malignant primary brain tumour originating in the CNS. Median patient survival is <15 months with standard treatment which consists of surgery alongside radiation therapy and temozolomide chemotherapy. However, because of the aggressive nature of GBM, and the significant toxicity of these adjuvant therapies, long-term therapeutic effects are unsatisfactory. Thus, there is urgency to identify new drug targets for GBM. Recent evidence shows that the transient receptor potential melastatin 7 (TRPM7) cation channel is aberrantly upregulated in GBM and its inhibition leads to reduction of GBM cellular functions. This suggests that TRPM7 may be a potential drug target for GBM treatment. In this study, we assessed the effects of the specific TRPM7 antagonist waixenicin A on human GBM cell lines U87 or U251 both in vitro and in vivo. First, we demonstrated in vitro that application of waixenicin A reduced TRPM7 protein expression and inhibited the TRPM7-like currents in GBM cells. We also observed reduction of GBM cell viability, migration, and invasion. Using an intracranial xenograft GBM mouse model, we showed that with treatment of waixenicin A, there was increased cleaved caspase 3 activity, alongside reduction in Ki-67, cofilin, and Akt activity in vivo. Together, these data demonstrate higher GBM cell apoptosis, and lower proliferation, migration, invasion and survivability following treatment with waixenicin A.
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Affiliation(s)
- Raymond Wong
- Departments of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Haifan Gong
- Departments of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Rahmah Alanazi
- Departments of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Andrew Bondoc
- Departments of Cell Biology SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Amanda Luck
- Departments of Cell Biology SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Nesrin Sabha
- Departments of Genetics and Genome Biology, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - F David Horgen
- Department of Natural Sciences, Hawaii Pacific University, Kaneohe, Hawaii, 96744, USA
| | - Andrea Fleig
- Center for Biomedical Research at The Queen's Medical Center and John A. Burns School of Medicine at the University of Hawaii, Honolulu, Hawaii, 96720, USA
| | - James T Rutka
- Departments of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Zhong-Ping Feng
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Hong-Shuo Sun
- Departments of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
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Uribe-Cardenas R, Boyke AE, Schwarz JT, Morgenstern PF, Greenfield JP, Schwartz TH, Rutka JT, Drake J, Hoffman CE. Utility of invasive electroencephalography in children 3 years old and younger with refractory epilepsy. J Neurosurg Pediatr 2020; 26:648-653. [PMID: 32947255 DOI: 10.3171/2020.6.peds19504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 06/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Early surgical intervention for pediatric refractory epilepsy is increasingly advocated as surgery has become safer and data have demonstrated improved outcomes with early seizure control. There is concern that the risks associated with staged invasive electroencephalography (EEG) in very young children outweigh the potential benefits. Here, the authors present a cohort of children with refractory epilepsy who were referred for invasive monitoring, and they evaluate the role and safety of staged invasive EEG in those 3 years old and younger. METHODS The authors conducted a retrospective review of children 3 years and younger with epilepsy, who had been managed surgically at two institutions between 2001 and 2015. A cohort of pediatric patients older than 3 years of age was used for comparison. Demographics, seizure etiology, surgical management, surgical complications, and adverse events were recorded. Statistical analysis was completed using Stata version 13. A p < 0.05 was considered statistically significant. Fisher's exact test was used to compare proportions. RESULTS Ninety-four patients (45 patients aged ≤ 3 [47.9%]) and 208 procedures were included for analysis. Eighty-six procedures (41.3%) were performed in children younger than 3 years versus 122 in the older cohort (58.7%). Forty-two patients underwent grid placement (14 patients aged ≤ 3 [33.3%]); 3 of them developed complications associated with the implant (3/42 [7.14%]), none of whom were among the younger cohort. Across all procedures, 11 complications occurred in the younger cohort versus 5 in the older patients (11/86 [12.8%] vs 5/122 [4.1%], p = 0.032). Two adverse events occurred in the younger group versus 1 in the older group (2/86 [2.32%] vs 1/122 [0.82%], p = 0.571). Following grid placement, 13/14 younger patients underwent guided resections compared to 20/28 older patients (92.9% vs 71.4%, p = 0.23). CONCLUSIONS While overall complication rates were higher in the younger cohort, subdural grid placement was not associated with an increased risk of surgical complications in that population. Invasive electrocorticography informs management in very young children with refractory, localization-related epilepsy and should therefore be used when clinically indicated.
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Affiliation(s)
- Rafael Uribe-Cardenas
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | | | - Justin T Schwarz
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | - Peter F Morgenstern
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | - Jeffrey P Greenfield
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | - Theodore H Schwartz
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | - James T Rutka
- 3Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Drake
- 3Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Caitlin E Hoffman
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York
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49
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Kondziolka D, Rutka JT. Editorial. The lessons of neurosurgery: a new publication for the Journal of Neurosurgery. J Neurosurg 2020:1-2. [PMID: 32886909 DOI: 10.3171/2020.8.jns203120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - James T Rutka
- 2Editor-in-Chief, Journal of Neurosurgery Publishing Group, Charlottesville, Virginia
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Kondziolka D, Couldwell WT, Rutka JT. Editorial. Putting pen to paper during a pandemic: increased manuscript submissions to the JNS Publishing Group. J Neurosurg 2020; 133:1-3. [PMID: 32707559 PMCID: PMC7393803 DOI: 10.3171/2020.7.jns202691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - James T. Rutka
- Editor-in-Chief, Journal of Neurosurgery Publishing Group, Charlottesville, Virginia
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